Healthcare Provider Details

I. General information

NPI: 1851403521
Provider Name (Legal Business Name): AFFILIATES IN DERMATOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 34TH STREET
OAKLAND CA
94609
US

IV. Provider business mailing address

460 34TH STREET
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-652-8091
  • Fax: 510-652-5156
Mailing address:
  • Phone: 510-652-8091
  • Fax: 510-652-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID PASLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 510-652-2926